Hypoglycemia and hyperglycemia in extremely low-birth-weight infants
Italian Journal of Pediatrics volume 41, Article number: A7 (2015)
Materials and methods
All inborn ELBW neonates admitted to our NICU during a 5-year period were eligible for this retrospective analysis. Exclusion criteria were: birth weight (BW) <400 grams, major congenital malformations, death during the first 24 hours of life. Hypoglycemia was defined as blood glucose level (BGL) ≤45 mg/dL; hyperglycemia as BGL>240 mg/dL in a single determination or >180 mg/dL in two determinations at 2-hour intervals. Continuous intravenous insulin infusion was started after an ineffective glucose restriction.
Of 195 ELBW infants, 29 (14.8%) were excluded and 166 (GA 26.7 2.1 weeks, BW 751 152 grams) were analyzed and grouped to their BGL. Normoglycemia was observed in 79 neonates (47.6%) (N-Group); 80 neonates (52.4%) showed abnormal BGL: 21 (12.7%) were hypoglycemic (Hypo-Group), 53 (31.9%) hyperglycemic (Hyper-Group) and 13 (7.8%) showed both hypoglycemia and hyperglycemia (Hypo&Hyper-Group). Clinical characteristics of the groups are reported in Table 1. Hypo-Group respect to N-Group showed a higher rate of small for gestational age (SGA) neonates (p=0.03). Hyper-Group in comparison to N-Group showed a tendency toward a lower GA (p=0.05), lower BW (p<0.001), higher sepsis rate (p<0.001), higher rate of treatment with inotropic agents (p=0.02), corticosteroids (p=0.006) and nonsteroidal antiinflammatory drugs (p=0.01). Hypo&Hyper-Group respect to N-Group showed similar GA, lower BW (p<0.001), higher sepsis rate (p<0.01), higher rate of inotropic treatment (p=0.04). Insulin was administered in 35 neonates (66%) of Hyper-Group and in 8 neonates (61.5%) of Hypo&Hyper-Group. Intraventricular Hemorrhage ( IVH) rate was higher in Hyper-Group and Hypo&Hyper-Group respect to N-Group (p=0.002) as well as IVH grade3 (p=0.001 and p=0.02, respectively).The rate of both Retinopathy of Prematurity ( ROP) and ROP ≥stage 2 in survived neonates was higher in Hyper-Group respect to N-Group (p=0.008 and p=0.002, respectively). Mortality was similar among the groups (Table 2).
Among ELBW infants, hypoglycemia occurs more frequently in SGA neonates, while hyperglycemia alone or a marked variability of BGL (hypo and hyperglycaemia) is more common in sick neonates. High rate of glucose homeostasis disorders highlights the importance of carefully monitoring BGL in order to a prompt management. Continuous glucose monitoring recently used in neonates  might be a useful tool for monitoring glucose changes also in ELBW neonates.
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De Carolis, M.P., Rubortone, S.A., Cocca, C. et al. Hypoglycemia and hyperglycemia in extremely low-birth-weight infants. Ital J Pediatr 41 (Suppl 1), A7 (2015). https://doi.org/10.1186/1824-7288-41-S1-A7
- Blood Glucose Level
- Continuous Glucose Monitoring
- Major Congenital Malformation